Chapter 17: Cardiovascular Emergencies Flashcards
circulatory system
aka the cardiovascular system, three major components: the heart, the blood vessels, the blood
cardiac conduction system
conductive tissue that generates electrical impulses that conduct rapidly to other heart cells
contractile tissue
enables heart muscle to contract when stimulated by electrical impulses
automaticity
the heart creates its own electrical impulses independent of the body
cor pulmonae
right-sided/right ventricular heart failure, happens when the pulmonary vessels are compressed/narrowed, increasing the force needed to pump blood through them, weakening the right ventricle over time
pulmonary edema
hypoxia and severe shortness of breath from fluid build up around the alveoli, leading to issues with gas exchange
myocarditis
infections of the heart
coronary arteries
the first two arteries to originate off of the aorta, supply the heart
thrombus
the clot that is formed in response to an injury
platelets
disk-shaped elements in the blood that are fragments of cells from bone marrow, important for clotting
thrombin
a protein responsible for activating clot formation
fibrin
protein strands that form a mesh that strengthens a clot
plaque
fatty deposit (in artery/vein)
dysrhythmias
cardiac rhythm abnormalities
electrocardiogram
ECG or EKG, a graphic representation of the heart’s electrical activity as detected from the chest wall surface
depolarization
first in the heartbeat, when electrical charges of the heart muscle change from negative to positive and cause heart muscle contraction
repolarization
the second component of the heartbeat, when the electrical charges of the heart muscle return to a resting negative charge and cause relaxation of the heart muscle
P wave
first waveform of ECG, represents depolarization (contraction) of the aorta
QRS complex
second waveform of ECG, represents the depolarization (contraction) of the ventricles and the main contraction of the heart
T wave
the third waveform of ECG, represents the repolarization (relaxation) of the ventricles
PR interval
PRI, the beginning of the P wave to the beginning of the QRS complex, the time it takes the heart’s electrical impulses to travel from the atria to the ventricles
premature ventricular complexes
PVC, the uncoordinated firing of electrical ventricular impulses
Ventricular tachycardia (V-Tach)
when PVCs occur in succession, displays on ECGs as steep peaks and valleys close together
Ventricular fibrillation (VF/V-Fib)
shows up on ECG as smaller, uneven, disorganized peaks and valleys
blood pressure
the amount of pressure exerted on the arterial wall during circulation, smaller vessels = higher blood pressure
coronary artery disease
CAD, the narrowing and hardening of the coronary arteries, the most common type of heart disease, responsible for more than 385,000 deaths each year (every 34 seconds someone in the US has a heart attack)
cardiac compromise
the many cardiac conditions
arteriosclerosis
condition that causes the smallest arterial structures to become stiff and less elastic
atherosclerosis
a systemic arterial disease in which plaque builds up inside the arteries, number one cause for myocardial infarctions and strokes
acute coronary syndrome
ACS, results from a variety of conditions that can affect the heart in which the coronary arteries are narrowed or occluded by fat deposits, clots, or spasm
myocardial ischemia
a state in which there is inadequate delivery of oxygen to the heart muscle, usually is chest discomfort (chest pain) localized to the sternum area and radiating to jaw, arms, shoulders, back
angina pectoris
pain in the chest, a symptom commonly associated with coronary heart disease
unstable angina
angina discomfort that i prolonged and worsening or that occurs without exertion and when patient is at rest
emergency medical care for angina
provide regardless of indications of an acute coronary syndrome, establish an open airway and do positive pressure ventilation if necessary, administer O2 if needed (nasal cannula), administer nitroglycerin or aspirin if indicated
acute myocardial infarction
AMI, occurs when part of the heart muscle dies because of the lack of an adequate supply of oxygenated blood, aka a heart attack, typically the result of CAD
assessment of AMI
similar discomfort to angina, but symptoms last longer and will not/will only partly be relieved by nitroglycerin
aortic aneurysm
a weakened section of the aortic wall begins to dilate or balloon outward from the pressure exerted by the blood flowing through the vessel, occur most often in abdominal region, can lead to rupture, pain can be felt when aneurysm gets large enough
aortic dissection
a tear in the inner lining of the aorta, blood enters the opening and causes separation of the layers of the aortic wall, most common in thorax, pain is most severe when dissection first occurs - “sharp, tearing, ripping”. Do not administer aspirin if suspected
acute coronary syndrome in females
- “classical” findings: dull substernal chest pain or discomfort, respiratory distress, nausea, vomiting, diaphoresis
- “nonclassical” or “atypical” findings: neck ache, pressure in check, pains in the back, breast, upper abdomen, finger tingling, unexplained fatigue or weight gain, epigastric pain, nausea/vomiting, insomnia
reperfusion
the restoration of blood to an area of tissue that was ischemic from low blood flow or occlusion of a vessel
heart failure
when the heart can no longer adequately eject blood out of the ventricle, can be caused by heart attacks, valve disorders, hypertension, pulmonary embolism, cardiac rhythm disturbances, pregnancy, viral illnesses, certain drugs
left ventricular failure
can lead to pulmonary edema from a “backup” of blood, symptoms include a drop in systolic BP, diminished or absent peripheral pulse amplitude, altered mental status, changes in the heart rate, poor urinary output, respiratory distress, inspiratory rales, possible pulmonary edema
right ventricular failure
blood backs up into venous system, hypoperfused lungs leading to hypoxia or respiratory distress, jugular venous distention, peripheral edema, poor peripheral perfusion signs
cardiogenic shock
when the left or right ventricle fails to pump out enough blood to meet the demands of the body
congestive heart failure
CHF, a medical diagnosis, the condition in which there is a buildup of fluid in the body resulting from pump failure of the heart, when left, right, or both ventricles are failing to meet the body’s needs
signs/symptoms of CHF
- marked or severe dyspnea
- tachycardia
- difficulty breathing when supine
- fatigue on any type of exertion
- suddenly waking at night with dyspnea
- anxiety
- tachypnea
- diaphoresis
- upright pisition with feet, legs, arms, hands dangling
- cool clammy pale skin
- chest discomfort
- cyanosis
- agitation/restlessness due to hypoxia
- edema to hands, ankles, feet
- crackles, wheezes on auscultation
- decreased SpO2 reading
- signs/symptoms of pulmonary edema
- BP can be low, normal, high
- distended neck veins
- distended and soft spongy abdomen
cardiac arrest
when the heart is not pumping effectively or at all, no pulses can be felt
nitroglycerin
most common medication for patients with known cardiac problems, a potent vasodilator
pediatric considerations
typically cardiac disturbances are from congenital heart condition that the family knows about, contact medical direction ASAP to get advice. best treatment for cardiac arrest in pediatric patients is preventing it by ensuring an open airway, adequate breathing, and oxygen supplementation
geriatric considerations
- history of diabetes mellitus (hard to perceive pain)
- history of trauma
- history of asthma (bronchoconstriction)
- history of COPD
levine sign
patient presenting with a fist clenched over the center of their chest, an indication of severe chest discomfort
fibrinolysis contraindications
- systolic or diastolic hypertension
- recent head or facial trauma
- recent stroke or any history of bleeding within the cranium
- pregnant
- any recent trauma or surgery
- recent history or gastrointestinal or genitourinary bleeding
- patient taking blood thinners or one who has a clotting disorder
- history of cancer, kidney disease, liver disease, or any other disease involving the central NS
- suspected aortic aneurism
percutaneous intervention
rapid removal of the clot (angioplasty)
fibrinolytics
dissolve clot
physical exam
- pupils
- oral cavity
- neck
- chest
- lower and upper extremities
- posterior body
emergency medical care steps
1) decrease patient’s anxiety: provide calm reassurance, place them in a comfortable position
2) administer supplemental O2 if patient is dyspneic, hypoxemic, has obvious signs of heart failure, has SpO2 <94% or SpO2 unknown
3) assist patient who has prescribed nitroglycerin
4) if protocol allows administer aspirin (uncoated, chew)
5) call ALS, initiate transport
